Practice and motivations for skin bleaching among Africans
Authors: Jesutofunmi I. Adetoogun, Nicholas Aderinto, Abidat A. Ashimi, Doyinsola F. Akano, Toluwase O. Ogundipe, Paul B. Fikayomi
Journal: International Journal of Surgery (2023)

Dear Editors, Despite the well-known potential harmful side effects of skin bleaching, it is still being practiced among Africans. Skin bleaching for cosmetic purposes was reported to be high and most common among African women. In African countries, about 25–80% of women regularly use skin-whitening products1. Some of the reasons for the act include the removal of acne, rashes, and skin blemishes; having soft skin; and achieving an even skin tone2. The practice of skin bleaching is not only native to Africa. It cuts across various races, ages, and genders. Although the practice was not well documented, it can be dated back to 200 BCE and was practiced across different civilizations. In Africa, there seems to have always been a close association between lighter skin color and beauty and attractiveness. In addition, the contribution of the transatlantic slave trade and colonialism to the motivation for skin bleaching cannot be disputed3. Due to low self-esteem that stems from colonialism and white supremacy, porcelain skin is seen as an indicator of beauty. Paradoxically, women who bleach are perceived as brash and lewd in most African societies. In today's world, bleaching has moved beyond the use of creams to the use of pills and injections. This multibillion-dollar global enterprise consists of transnational cosmetic companies and local merchants. The prices of the products also vary greatly, thereby making the cheaper ones affordable for the masses. A lot of the consumers of these products are Africans. This is evidenced by the presence of words descriptive of bleaching and its effects in the vernacular of many places across Africa. The skin fairness industry is considered one of the fastest-growing beauty industries and is estimated to reach US$31.2 billion by 20244. The industry thrives on advertisements that promote fair skin as the key to attractiveness, improved social status, and privilege. These advertisements finally present skin bleaching as the means to achieving the highlighted benefits. In 2011, the WHO reported that over 40% of African women bleach their skin5. The prevalence varies among countries, from 77% in Nigeria to 59% in Togo, 35% in South Africa, and 25% in Mali6. Historically, skin-lightening has been associated with the female gender, as women are more likely to be judged according to their appearance, have less capital than men, and experience worse body image7. Studies have established skin bleaching as a contemporary expression of colorism, as evidenced by the motivations admitted by individuals who persist in the use of skin-lightening products despite known adverse effects8,9. A significant positive correlation has also been found between relationship status and skin bleaching, indicating that some African women bleach their skin to attract and/or satisfy partners10. While some researchers explain the unrelenting use of skin-lightening products despite their attendant complications as a demonstration of self-hatred and low self-esteem attributable to decades of colonialism and oppression, others argue that skin bleachers only seek to liberate themselves from the negative connotations of black skin and bleach their skin to demonstrate the fact that they see themselves as fluid and changeable6,7. There are several African countries with established prohibitions against the production, import, and over-the-counter sale of bleaching products containing certain harsh substances. However, suboptimal implementation of these laws has left Africa as a destination point for bleaching products from Europe and Asia containing dangerously high concentrations of these substances. A global regulatory framework is also needed to jointly tackle bleaching and newer whitening products by larger brands since the sustenance of the former will result from an expansion of the market for the latter. This may result in poorer consumers or those desiring tangible outcomes seeking out harsher bleaching products. Public health agencies and professionals should develop broad strategies that will continually create awareness of the dangers of skin bleaching to discourage this practice. The strategies involved should consider cultural and socioeconomic motivations for skin bleaching for effectiveness. Misinformation regarding the efficacy and effects of skin bleaching products should be countered through advocacy for policies aimed at regulating the advertisements of these products and their plausible false contents. Supporting developments and enforcements of the availability and use of skin bleaching products by an informed public might not be difficult and is a step further in curbing this practice. The perpetuation of the socioeconomic benefits of light skin continues to undermine public health messaging; hence, a shift to a focus beyond health concerns is needed. Increasing local and diaspora anticolorism campaigns to expand discussions on beauty and self-esteem can help reinforce public health messaging. Prospective studies focused on measuring skin color biases in various countries and the impacts of colorism can aid the continuity of anticolorism campaigns. Additional research on the psychology of complexion might serve as a springboard for the development of health models to encourage the embracement of an individual's natural skin tone.